title: An evidence based strategy for follow up after breast conserving treatment for breast cancer.
abstract: OBJECTIVE
  Follow up for breast cancer patients aims at the timely detection of loco-regional recurrences and contralateral breast cancers (LRR). This study investigates the annual risk of LRR after breast conserving treatment (BCT) and the potential value of mammographic surveillance and/or routine clinical examination.
  
  
  METHODS
  Data on 650 women who underwent BCT were obtained and LRR was divided into parenchymal and non-parenchymal. LRR-free and cumulative LRR-free rates were calculated. In patients where recurrence was diagnosed at a routine clinic visit and had negative mammography ("clinical detection only" group) were also separately examined.
  
  
  RESULTS
  Median follow up was 115 months, range 9-196. Seventy-three patients had parenchymal and 16 nodal recurrence. The median probability of LRR was 1.4% and of parenchymal LRR was 1.32% per year, remaining constant for up to 168 months. The 16 patients in the "clinical detection only" group relapsed mainly during the first 2 years (annual risk 0.77% and 0.80%, respectively).
  
  
  CONCLUSIONS
  This study shows that the risk of parenchymal LRR remains constant for at least 14 years and is significant enough to warrant routine long-term follow up mammography. Routine clinical examination contributes significantly to the detection of LRR only for the first 2 years.
authors.affiliation: Breast Unit, Guy's and St. Thomas' NHS Foundation Trust, London, UK. michalis_kontos@yahoo.com
authors.forename: Michael
authors.initials: M
authors.lastname: Kontos
authors.forename: Pratik
authors.initials: P
authors.lastname: Roy
authors.forename: Demetrios
authors.initials: D
authors.lastname: Rizos
authors.forename: Hisham
authors.initials: H
authors.lastname: Hamed
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D015412:Mastectomy, Segmental; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis*; D015996:Survival Rate; D016896:Treatment Outcome